Bike Safety: Evidence-Based Nursing Research

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Author (year)	Purpose	Sample / Number of Participants	Design	Level of Evidence	Findings	Limitations
Hooshmand, Hotz, Neilson, & Chandler (2014)	To assess the effectiveness of a curriculum program as a means of expanding knowledge and bike injury reduction	A cohort of 193 students from 6 middle schools participating in the BikeSafe curriculum program	A cohort studytracking the outcomes before and after the curriculum program was implemented	Level IV: evidence from a cohort study	A considerable improvement of knowledge could be traced in all children, with minimal error. The class period did not prove significant when analyzing the results. Thus, the study established that the curricular activities concerned with bike safety improve and extended the children’s knowledge on the subject	Small sample size; The variables do not include gender; While the knowledge is improved, it is still questionable whether the children are going to use it when using their bicycles
Kaushik, Krisch, Schroeder, Flick, & Nemergut (2015)	To estimate the rate of bike injuries in Olmsted County, Minnesota, which does not have official law on using bicycle helmets	A cohort of 1189 children and adolescents (5 to 18 years of age) registered with bicycle-related injuries from 2002 to 2011	A medical record based case-control studycomparing the injury outcomes of a group wearing and not wearing a helmet	Level IV: evidence from a case-control study	Overall, head injuries amounted to 104 for girls and 255 for boys, with only 17.4% of total amount of injured wearing a helmet. Those without a helmet at the moment of the accident were approximately twice as likely to go through head MRI and be diagnosed with a brain trauma	Data from less serious injuries was not collected; The sample included white educated population with middle-SES, overlooking other socio-economical categories and backgrounds
Phillips et al. (2016)	To determine the tendencies of bicycle helmet usage among children and evaluate the rates of mortality and traumatic brain injuries (TBI)	A national representative sample of 16,681 patients under 17 years with NTDB (National Trauma Data Bank) records related to bike injuries in 2003-2004 and 2007-2010	A retrospective descriptive studyassessing the risk of mortal injuries and TBI among bicycle users under 17 in the US	Level VI: evidence from a single descriptive study	It was estimated that only 21% of patients were using their helmets at the moment of accident. The tendency to use helmets showed a significant recession from 28% to 19% from the two periods analyzed. Patients 6 to 9 years old were more likely to wear a helmet while pre-adolescents and adolescents were under greater risk of injury due to not wearing one. Overall, there were 121 incidents of mortality among non-helmet wearers as opposed to 21 fatalities among those wearing a helmet at the moment of accident	Retrospective studies cannot be used to make predictions; No follow-up is present; 41% of bike-related injuries were not assessed due to lack of helmet usage record; Other protective devices were unassessed
Rivara, Thompson, & Thompson (2015)	To allocate risk factors for bicycle-users to receive injuries not related with helmet wearing	A convenience sample of 3854 bicyclists registered in seven Seattle hospitals during a three-year period, excluding those suffering a physical assault when cycling	A prospective case-control studycomparing risk factors in a group of individuals with bicycle-related injuries	Level IV: evidence from a case-control study	Of the 3390 individuals who have provided the questionnaires, 51% had their helmets on at the moment of the accident. The risk factors included car or motorcycle collisions, bike speeding, being under age or aged more than 39. With these factors considered, helmet usage did not affect the incidents rate	Gender was not identified as a variable; The analysis was based on self-reported results

Summary

The research question addressed in the given summary table is whether using a helmet can be considered an adequate measure of bike injury prevention among pre-adolescent and adolescent bicycle users. The search for articles was predetermined by the articles’ contents and the level of evidence they provided. The articles give several perspectives of the issue we are trying to find the answer to.

It can be assumed that the higher the quality of evidence, the more exact the research results will be. To address a critical issue such as bike safety, it is necessary to make sure the evidence is reliable and credible, which is why, for the current paper, we have deployed three Level IV sources and one Level VI source. The works by Hooshmand et al. (2014), Kaushik et al. (2015), and Rivara et al. (2015) are well-designed pieces of scholarly writing that reflect the goal of the research. The article by Phillips et al. (2016) is descriptive but we have chosen it due to the recency of publication and the large sample size that speaks for enhanced exactitude of the findings.

All in all, the findings suggest that the usage of helmet tends to decrease with time among bicyclists in the US, especially the pre-adolescent and adolescent ones. Age, for one, has been estimated to be a critical risk factor of bike-related injuries, which is why pre-adolescents and adolescents can be regarded as a risk group (Rivara et al., 2015). It was estimated, for instance, that only 21% of all injured bicyclists under 17 wore helmets at the moment of crash within the timeline of 2003-2004 and 2007-2010 (Phillips et al., 2016). At that, the programs designed to educate youngsters about safe cycling and safety devices to be used seem inconsistent. Although the BikeSafe curricular activity was thoroughly tested as to its efficiency, the results did not include whether children were actually going to use the knowledge they acquired during this activity (Hooshmand et al., 2014). Whether the accidents are likely to happen or not does not seem to be predetermined by usage or non-usage of helmets when cycling; on the other hand, the lack of helmet at the moment of accidents usually results in more serious injuries, TBIs, and mortalities. The figures speak for themselves: the likelihood of undergoing MRI and being diagnosed with brain traumas is twice as big when the injured cyclist does not have a helmet; the level of mortality among non-helmet-using children and teenagers is five times as high as that among helmet-users (Kaushik et al., 2015; Phillips et al., 2016). Consequently, the usage of helmet can be regarded as a preventative measure, although its effectiveness taken separately or combined with other safety devices is yet to be estimated.

The sampling in the sources can be considered adequate. The smallest sampling here is provided by Hooshmand et al. (2014) but the level of evidence this study provides can compensate for a relatively small sample size. The study by Phillips et al. (2016) bases its findings on the most extensive sample of the four; it includes a national representative sample of 16,681 injured cyclists under 17, which recoups for the descriptive design of this study and the fact that it is retrospective.

Although we have opted for maximum exactitude, each of the studies on our list has limitations. Because of the relatively small sample size, the first study that we have enlisted might be limited with regard to the precision of the findings. The other articles do not present any troubles, at that. On the other hand, the second and the third studies are limited in terms of inclusion; it might seem that too many incidents were excluded due to either the triviality of injuries or socio-economic background. As to the last one on our list, it does not account for gender as a variable and a possible risk factor for injuries. Other limitations include non-assessment of other safety means and devices that could be used to prevent or ease the condition of injuries, such as enhanced frames, smart lighting, louder horns, and more.

Overall, the research issue we have estimated as crucial can be partially answered by the findings. The literature suggests that using helmets does not suffice in preventing bike-related injuries whatsoever; on the other hand, it can be concluded that it can protect young cyclists from serious TBIs and significantly reduce the level of mortality. During out investigation, we have found out the existence of additional risk factors include collisions with motor vehicles, especially when the cyclists are of young age and without a helmet. To assess whether helmet usage can help reduce the amount of serious injuries and fatalities in accidents involving cars and motorcycles and underage children, additional research is needed.

References

Hooshmand, J., Hotz, G., Neilson, V., & Chandler, L. (2014). BikeSafe: Evaluating a bicycle safety program for middle school aged children. Accident Analysis & Prevention, 66, 182-186.

Kaushik, R., Krisch, I. M., Schroeder, D. R., Flick, R., & Nemergut, M. E. (2015). Pediatric bicycle-related head injuries: a population-based study in a county without a helmet law. Injury Epidemiology, 2(16), 1-9.

Phillips, J. L., Overton, T. L., Campbell-Furtick, M., Nolen, H. P., Gandhi, R. R., Duane, T. M., & Shaf , S. (2016). Bicycle Helmet Use Trends and Related Risk of Mortality and Traumatic Brain Injury among Pediatric Trauma. Journal of Epidemiology and Public Health Reviews, 1(1), 1-6.

Rivara, F. P., Thompson, D. C., & Thompson, R. S. (2015). Epidemiology of bicycle injuries and risk factors for serious injury. Injury Prevention, 21(1), 47-51.

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Bike Safety: Evidence-Based Nursing Research

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